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目的探讨纤维支气管镜局部灌洗治疗对急性肺脓肿临床有效性及生活质量的影响。方法选取2012年9月—2013年6月本院呼吸内科收治的急性肺脓肿患者110例作为研究对象,随机分为对照组和研究组各55例。对照组采取常规内科综合治疗,包括敏感抗生素结合体位引流、湿化气道、祛痰、雾化治疗,对症治疗并发症及全身营养支持等。研究组在对照组的基础上加用经纤维支气管镜肺泡灌洗,局部给药。观察比较两组患者的住院时间,肺部啰音、脓腔、体温恢复、咳嗽咳痰等临床症状的缓解时间,评估临床疗效,观察治疗前后动脉血气指标变化情况。出院6个月随访时,利用SF-36健康调查表进行生活质量评价。计量资料组间比较采用t检验,组内比较采用配对t检验,计数资料采用χ~2检验,P<0.05为差异有统计学意义。结果研究组总有效率为100.0%,明显高于对照组的61.8%,差异有统计学意义(P<0.05)。研究组住院时间、肺部啰音消失时间、脓腔消失时间、体温恢复时间、咳嗽咳痰缓解时间分别为(16.1±2.4)、(11.8±1.6)、(13.9±1.5)、(6.1±0.4)、(10.9±0.9)d,均优于对照组的(22.3±2.9)、(17.9±2.8)、(19.6±2.8)、(9.1±0.6)、(14.8±2.3)d,差异均有统计学意义(均P<0.05)。治疗后,研究组与对照组FEV1、FVC、Pa O2水平分别为(3.26±0.38)、(3.86±0.18)L、(80.9±7.3)mm Hg(1 mm Hg=0.133 k Pa)、(2.86±0.19)、(3.24±0.21)L、(70.9±2.3)mm Hg,均较治疗前的(2.19±0.27)、(2.41±0.29)L、(61.5±1.0)mm Hg、(2.12±0.34)、(2.39±0.36)L、(61.2±1.3)mm Hg改善明显,差异均有统计学意义(均P<0.05)。出院后6个月,研究组的躯体功能、躯体角色、躯体疼痛、总体健康、精力、社会功能、情感职能、心理卫生得分分别为(85.8±11.4)、(65.4±16.7)、(82.3±14.5)、(80.3±10.8)、(88.8±13.6)、(93.1±4.9)、(85.9±12.5)、(82.5±7.3)分,均明显高于对照组的(54.7±20.3)、(30.5±14.2)、(61.9±17.5)、(28.1±11.5)、(46.3±18.2)、(53.4±15.2)、(34.8±15.3)、(46.7±14.1)分,差异均有统计学意义(均P<0.05)。结论急性肺脓肿在常规内科治疗基础上配合纤维支气管镜肺泡灌洗可显著改善患者病情,缩短疗程,降低住院费用,避免手术治疗带来的创伤及痛苦,安全性良好,有效提高生活质量,值得临床推广。
Objective To investigate the effect of local bronchoscopy on the clinical efficacy and quality of life of patients with acute lung abscess. Methods A total of 110 patients with acute lung abscess admitted to our hospital from September 2012 to June 2013 were selected as study subjects and randomly divided into control group and study group of 55 cases. The control group to take conventional medical comprehensive treatment, including the combination of sensitive antibiotics drainage, wet airway, expectorant, atomization, symptomatic treatment of complications and nutritional support. The study group in the control group based on the use of bronchoscopic alveolar lavage, local administration. The duration of hospital stay, pulmonary rales, abscess, body temperature recovery, cough and sputum were compared between the two groups to observe the clinical symptoms, to assess the clinical efficacy, and to observe the change of arterial blood gas index before and after treatment. At 6 months of follow-up at discharge, quality of life was assessed using the SF-36 Health Questionnaire. Measurement data were compared between groups using t test, the group was compared using paired t test, count data usingχ ~ 2 test, P <0.05 for the difference was statistically significant. Results The total effective rate was 100.0% in the study group, which was significantly higher than that in the control group (61.8%), the difference was statistically significant (P <0.05). The time of hospitalization, disappearance of pulmonary rales, disappearance of abscess, recovery time of body temperature and cough and expectoration were (16.1 ± 2.4), (11.8 ± 1.6), (13.9 ± 1.5) and (6.1 ± 0.4 ) And (10.9 ± 0.9) d in the control group were significantly higher than those in the control group (22.3 ± 2.9), (17.9 ± 2.8), (19.6 ± 2.8), (9.1 ± 0.6) and (14.8 ± 2.3) d respectively Significance (both P <0.05). After treatment, the levels of FEV1, FVC and Pa O2 in study group and control group were (3.26 ± 0.38), (3.86 ± 0.18) L, (80.9 ± 7.3) mm Hg (1 mm Hg = 0.133 kPa) (2.19 ± 0.27), (2.41 ± 0.29) L, (61.5 ± 1.0) mm Hg, (2.12 ± 0.34), (2.24 ± 0.21) L and (70.9 ± 2.3) mm Hg before treatment were significantly higher than those before treatment (2.39 ± 0.36) L, (61.2 ± 1.3) mm Hg, the difference was statistically significant (all P <0.05). Six months after discharge, the scores of body function, body function, body pain, general health, energy, social function, emotional function and mental health were (85.8 ± 11.4), (65.4 ± 16.7) and (82.3 ± 14.5 ), (80.3 ± 10.8), (88.8 ± 13.6), (93.1 ± 4.9), (85.9 ± 12.5) and (82.5 ± 7.3) in the control group were significantly higher than those in the control group (54.7 ± 20.3, 30.5 ± 14.2 ), (61.9 ± 17.5), (28.1 ± 11.5), (46.3 ± 18.2), (53.4 ± 15.2), (34.8 ± 15.3) and (46.7 ± 14.1), respectively ). Conclusions Acute pulmonary abscess with bronchoscopy and bronchoalveolar lavage can significantly improve the patient’s condition, shorten the course of treatment, reduce the cost of hospitalization, avoid the trauma and pain caused by surgical treatment, and improve the quality of life effectively. Clinical promotion.